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The Children's Hospital Boston Applications Maximizing Patient Safety project, known by its "CHAMPS" acronym, officially kicked off in mid-2004 and has achieved several major milestones. This multi-phase, multi-year initiative was designed to improve the clinical care information systems used at Children's Hospital Boston in several ways.
As its name implies, increasing patient safety is the paramount goal of the project. This is (or will be) accomplished in several ways, including implementation of Computerized Provider Order Entry (CPOE) with decision support, including dose-range checking, drug-allergy checking and drug-lab-value checking; creation of a single source for allergy documentation; bar coding of medications, laboratory specimens and patient wristbands; electronic medication administration recording at the bedside using wireless handheld devices. Another major
way in which the project should improve Children's ability to care for patients is to aggregate essentially all documentation regarding patient care, both in- and outpatient, into a single electronic source. This will allow easier, timelier and more complete access to key aspects of a child's medical history so clinicians can make better decisions for that patient's care moving forward.
Children's partnered with the Cerner Corporation to develop CHAMPS applications with the unique needs of pediatric patients and caregivers in mind. CHAMPS consists of many phases. Over the last two years, Children's has successfully:
- replaced the Pharmacy, Laboratory and Pathology systems
- replaced the results and documents viewing application
(Results Reporting with PowerChart)
- transitioned almost all nursing documentation (except the progress notes) into PowerChart, including vital signs, heights, weights, I&Os, medication administration and
nursing assessments
- moved pre-anesthesia documentation into PowerChart
- moved from paper-based ordering of medications to
electronic ordering
For the first time, clinicians can log in to a single computer workstation, even from outside the hospital, and view all aspects of a patient's care: medications (ordered and administered), all labs, all procedure reports, most radiographic images, all historical documentation (including ambulatory documentation), growth charts, future appointments and demographics.
In June, Children's began transitioning ambulatory programs to CPOE and full electronic nursing documentation as well, with five clinics going live. All of the decision support that makes medication ordering safer in the inpatient setting is being used
in outpatient settings as well. Children's will continue to transition clinics in a phased manner through the end of this year and into 2008, until all of our outpatient programs are fully online.
These implementations have not been without challenges. Most notably, our three ICUs (cardiac, medical/surgical and neonatal) found that the system did not initially perform fast enough to allow for its use without altering workflows and carefully established practices. We have, therefore, temporarily reverted to those systems in place in the ICUs prior to
deployment of CHAMPS to allow us time to resolve the performance and design issues that negatively impacted staff. We expect to resolve these issues soon and resume use of the system in these parts of the hospital.
More changes are on the way. Children's is currently working on multiple clinical projects, including implementation of new peri-operative and radiology systems that are fully integrated with all existing CHAMPS components, a high volume document scanning process within Medical Records for any remaining paper that is generated during a child's care, transition of remaining nursing and physician documentation from paper to electronic and piloting handheld medication documentation by nurses at the patient's bedside.
Finally, we are also working on a Web-based Patient Portal that can be used by patients (or their guardians) to access their own health information in a personally controlled medical record. Read more about this in future issues of Pediatric Views.
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